The Richmond, Virginia-based 4th U.S. Circuit Court of Appeals affirmed an existing permanent injunction. It wrote that the administration's rules “failed to recognize and address the ethical concerns of literally every major medical organization in the country" and “arbitrarily estimated the cost” of implementing part of the rules.
The decision, which came in a lawsuit filed by Baltimore city officials, means Maryland remains the only state where enforcement of the rules is enjoined.
Earlier this year, the 9th U.S. Circuit Court of Appeals allowed the administration’s changes to start taking effect and later upheld the rules, which also prohibit clinics in the program from sharing office space with abortion providers.
Abortion opponents and religious conservatives have argued Title X has long been used to indirectly subsidize abortion providers.
Abortion rights supporters have characterized the referral restrictions as a “gag rule." They also argued that the physical separation rule would force many providers to find new locations, undergo expensive remodels or shut down, reducing access to the program that provides birth control, reproductive care and other health care services including breast and cervical cancer screenings and HIV testing.
Planned Parenthood and some other providers decided to withdraw from the program rather than comply. Since then, some of the rejected federal funds have been replenished by state or local funds.
Baltimore Mayor Bernard C. “Jack” Young praised the ruling. He said in a statement that it would protect thousands of patients who rely on the program for contraception and other family planning services.
“While we celebrate today’s win for Maryland providers and their patients, our fight endures to restore the integrity of our nation’s family planning program for the millions of people across the US most in need of high-quality family planning care,” Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, said in a statement.
Neither the Justice Department nor the Department of Health and Human Services immediately responded to requests for comment.
Judge Stephanie Thacker, a nominee of President Barack Obama, wrote the court's opinion. She was joined by seven other judges.
Judge Julius Richardson, who was nominated by President Donald Trump, wrote a dissenting opinion and was joined by five other judges. He wrote that the final rule “falls well within HHS’s established statutory authority, and the record shows that it was a product of reasoned decisionmaking.”
Associated Press reporter Brian Witte in Annapolis, Maryland, contributed to this report.